Weight loss after pregnancy: challenges and opportunities

Abstract

It is important to pay attention to weight management before and between pregnancies, as women have an increased risk of weight gain during the reproductive years. Having a baby is a life-changing event for women and the challenge of weight management amidst this period of major physiological, psychological and social change should not be underestimated. However, the postpartum period offers an opportune time for lifestyle interventions, as women may have heightened awareness of their own and their wider families' health. Systematic reviews indicate that interventions including both diet and physical activity along with individualised support and self-monitoring are more likely to be successful in promoting postpartum weight loss. However, high levels of attrition and poor engagement have been an issue in previous trials in this area. Since postpartum women are difficult to reach and retain, future research must consider how to make weight-management interventions an attractive and attainable proposition for women who are juggling multiple, competing demands on their time. Ideally, intervention approaches need to be flexible and allow sustained contact with women, to facilitate a focus on maintenance of weight loss, as well as opportunities for re-engagement after life events that may disrupt weight-management progress. Using technology to deliver or support interventions holds promise but trials are needed to generate a range of appealing, effective and scalable options for postpartum women. What works at other life stages may not necessarily work here owing to specific barriers to weight management encountered in the postpartum period.

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

“…11,12 Weight gain trends during and after pregnancy Women are at an increased risk for weight gain during the reproductive years, and this weight gain can set women on an upwards weight trajectory for the decades ahead. 13 It has been estimated that between 40% and 65% of women in the UK gain too much weight during pregnancy. 14 This trend is particularly evident in women who start their pregnancy overweight or obese, 15 as well as among those of a lower socioeconomic status.…”

“…16 Excessive gestational weight gain and a high pre-pregnancy body mass index (BMI) are both predictors of postpartum weight retention [17][18][19][20][21] and are influenced by many other maternal factors, including diet and physical activity behaviours, breastfeeding, sleep, ethnicity, maternity leave, income and mental health. 13,21 Failure to lose pregnancy-related weight by 6 months post partum is considered an important predictor of obesity and associated conditions in mid-life; 22,23 many women with obesity attribute the onset of the condition to weight gained in pregnancy. 24 Between 40% and 50% of women who are overweight pre pregnancy move into the obese BMI category by 12 months postpartum.…”

“…The postpartum period can also be viewed as the 'interpregnancy' period for many women, as they will go on to have more children and will experience subsequent pregnancies. 13 Given that the times during and after pregnancy are periods of significant risk for the onset and maintenance of long-term weight-related issues, 21,30 not only will this pose risks to women's health, 15 but it may also increase the risk of adverse outcomes during subsequent pregnancies. 11,12,31,32 The postpartum period represents a unique and challenging period in a woman's life, both emotionally and physically.…”

“…45,46 The postpartum period could be an ideal time to intervene to shape new health behaviours as women have shown motivation for weight loss during this time, 47,48 and they may have a heightened awareness of their own and their families' health, and so may be receptive to information about lifestyle. 13 It is also a time when many women start to prepare for the next pregnancy, so there is the potential to set women on a positive course for subsequent pregnancies. 13 However, women have highlighted a need for additional weight management support during the postpartum period as little is currently provided.…”

Do lifestyle interventions during pregnancy have the potential to reduce long‐term postpartum weight retention? A systematic review and meta‐analysis

“…Postpartum weight retention (PPWR) has been identified as an important contributory factor in the rising prevalence of obesity among women of reproductive age . Substantial PPWR, defined as weight retention of either over 10 lb (4.55 kg), or 5 kg occurs in about 50% of women at 6 months postpartum and in about 25% of women at 12 months postpartum . Weight retention following pregnancy may not only increase the risk of developing persistent obesity but is also associated with a number of health consequences postpartum, in subsequent pregnancies, and throughout women's lives .…”